The role of small-colony variants in failure to diagnose and treat biofilm infections in orthopedics

Acta Orthop. 2007 Jun;78(3):299-308. doi: 10.1080/17453670710013843.


Biomaterial-related infection of joint replacements is the second most common cause of implant failure, with serious consequences. Chronically infected replacements cannot be treated without removal of the implant, as the biofilm mode of growth protects the bacteria against antibiotics. This review discusses biofilm formation on joint replacements and the important clinical phenomenon of small-colony variants (SCVs). These slow-growing phenotypic variants often remain undetected or are misdiagnosed using hospital microbiological analyses due to their unusual morphological appearance and biochemical reactions. In addition, SCVs make the infection difficult to eradicate. They often lead to recurrence since they respond poorly to standard antibiotic treatment and can sometimes survive intracellularly.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents / administration & dosage
  • Arthroplasty, Replacement / adverse effects*
  • Bacteria / genetics
  • Bacteria / growth & development
  • Bacterial Adhesion / drug effects
  • Bacterial Infections / diagnosis*
  • Bacterial Infections / drug therapy
  • Bacterial Infections / microbiology
  • Biofilms* / drug effects
  • Biofilms* / growth & development
  • Coated Materials, Biocompatible
  • Humans
  • Joint Prosthesis / microbiology*
  • Phenotype
  • Prosthesis Failure
  • Prosthesis-Related Infections / diagnosis*
  • Prosthesis-Related Infections / drug therapy
  • Prosthesis-Related Infections / microbiology
  • Recurrence
  • Staphylococcus aureus / genetics
  • Staphylococcus aureus / growth & development
  • Virulence Factors / biosynthesis


  • Anti-Bacterial Agents
  • Coated Materials, Biocompatible
  • Virulence Factors